Organization
E SQUARED COMMUNITY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EMILY DIANE LEAK (PRESIDENT)
(919) 218-7161
Entity
Organization
Contact information
Practice address
608A W BROAD ST, DUNN, NC 28334-4812
(910) 891-7680
(910) 891-7682
Mailing address
PO BOX 388, LILLINGTON, NC 27546-5830
(910) 891-7680
(910) 891-7682
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5915537
—
NC
05
—
6005945
—
NC
05
—
8301695
—
NC
05
—
8301695B
—
NC
05
—
8301695G
—
NC
05
—
8301695H
—
NC
05
—
8301695V
—
NC
Enumeration date
12/20/2006
Last updated
01/07/2011
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